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Guides you through decision to take medicines to treat MS (called disease-modifying therapy). Covers medicine choices. Covers side effects. Lists reasons for and against taking medicines. Includes interactive tool to help you make your decision.

Multiple Sclerosis: Should I Start Taking Medicines for MS?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Your options

Take medicines after your first attack of multiple sclerosis or as soon as you are diagnosed.

Don't take medicines now. Wait to see how the disease
progresses.

Key points to remember

Your doctor may suggest medicines after your first attack or when
multiple sclerosis (MS) is first diagnosed. Lasting
damage to the
nervous system can occur in the early stages of MS.
Early treatment may prevent or delay some of this damage.

Some
people wait to see if their symptoms get worse before they make a decision to
start taking MS medicines. Instead of medicines, you can try physical therapy,
occupational therapy, and
steroid shots to help you manage your symptoms.

It's hard to know the course that your MS will take. Doctors
can't know for sure if your MS will get worse. A small number of people with MS
have only mild disease and do well without treatment. But many get worse over
time.

Medicines can reduce the severity of attacks of
relapsing-remitting MS and how often you have them.
They may also reduce or delay disability. But they don't work for everyone. And
there is no way to predict if they will work for you.

These medicines have side effects that can range from flu-like
symptoms to headaches, chest pain, flushing, infections, and allergic reactions to the injection. Some of these medicines can damage your liver or heart.

These medicines are costly.
Your cost will depend on your health plan coverage.

Multiple sclerosis is a disease that affects the
central nervous system—the brain, spinal cord, and optic nerves. It is also called MS. It
can cause problems with muscle control and strength, vision, balance, feeling,
and thinking.

Your nerve fibers have a protective covering called
myelin. Without myelin, the brain and spinal cord
can't communicate with the nerves in the rest of the body. MS slowly destroys
myelin and nerve cells in the central nervous system. This causes muscle weakness and other
symptoms.

Most of the time, MS is not diagnosed unless a doctor
can be sure you have had at least two attacks affecting at least two different areas of your central nervous system. Your doctor will examine you,
ask you questions about your symptoms, and do some tests. An
MRI scan is often used to confirm the diagnosis. That's because
the patches of damage (lesions) caused by MS attacks can be seen with
MRI.

MS is different for each person. You may go through life with
only minor problems. Or you may become seriously disabled. Most people are
somewhere in between. In general, MS follows one of four courses:

Relapsing-remitting. This means symptoms fade and
then return off and on for many years.

Secondary progressive, which at first follows a
relapsing-remitting course and then becomes progressively worse. "Progressive" means it
gets worse over time.

Primary progressive. This means the disease is progressive from the
start.

Progressive relapsing. This means the
symptoms are progressive at first and are relapsing later.

Disease-modifying
therapy means treatment to delay, change, or interrupt the natural course of
the disease. For MS, this means taking medicine over a long period of time to
reduce not only the number of attacks but also how bad they are.

To slow down
the spread of MS, your doctor may suggest medicines after your first attack or when you are first
diagnosed with MS. People treated soon after being diagnosed with MS may have
better results than those who delay treatment. Lasting damage to the
nervous system can occur in the early stages of MS.
Early treatment may prevent or delay some of this damage.

Medicines for MS can be costly. They don't work for everyone. And it's hard to know who
will benefit.

The most commonly used medicines are:

Interferon beta (such as Betaseron).

Glatiramer (Copaxone).

Other disease-modifying medicines may also be used for relapsing-remitting MS. These medicines are available as pills that you take by mouth. They include:

Dimethyl fumarate (Tecfidera).

Fingolimod (Gilenya).

Teriflunomide (Aubagio).

Making a decision about starting disease-modifying therapy
can be hard, especially if your symptoms have been mild. Some people wait to
see if their symptoms get worse before they make a decision to start therapy. A
small number of people with MS may never have more than a few mild episodes and
never have any disability. But there is no way to know who will fall into this
group.

Medicines can't
cure MS. They don't stop disease activity or reverse nervous system damage that
has already happened. But drugs may reduce relapses and delay disability in
many people with relapsing forms of MS.

The medicines interferon beta and glatiramer have the most evidence to support how well they work. These medicines can reduce how often you have relapses and how bad the relapses are. They may also delay disability in some people and slow the number of new patches of damage (lesions).1, 2

The medicines dimethyl fumarate, fingolimod, and teriflunomide can also reduce the number of relapses in people who have relapsing-remitting MS.3, 4, 5 These medicines are newer and haven't been studied as long. So there isn't as much evidence yet for how well they work over time.

If you decide not to try disease-modifying therapy at
this time, work with your doctor to monitor your health through regular
checkups and periodic MRI scans to evaluate whether the disease is progressing.
If new lesions are developing or existing lesions are growing, you may want to
reconsider your decision and begin treatment.

If you decide
not to take MS medicines, there are some other things you can do.

Take other medicine, such as
steroid medicine, to relieve symptoms during attacks
or relapses.

Try
physical therapy,
occupational therapy, and other treatment you can do
at home to help you manage your symptoms and adjust to living and working with
MS.

Do what you can to stay well. Eat a healthy
diet, get plenty of rest, and try to reduce
stress.

Some people try alternative therapy to reduce their symptoms. Before you try any type of alternative treatment for MS, talk with your doctor about your treatment options. You can also
get advice from an MS treatment center or the National Multiple
Sclerosis Society.

Risks

With interferon beta, 48 out of 100 may have flu-like symptoms. This means that 52 out of 100 may not. The quality of the evidence about this is moderate.

With glatiramer, 24 out of 100 may have symptoms such as flushing, chest tightness, sweating, heart palpitations, anxiety, and shortness of breath. This means that 76 out of 100 may not. The quality of the evidence about this is borderline.

Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.

The
National Multiple Sclerosis Society recommends that people with a definite
diagnosis of MS and active, relapsing disease start treatment with interferon
beta or glatiramer. Most
neurologists support this recommendation and now agree
that permanent damage to the
nervous system may occur early on, even while symptoms
are still quite mild. Early treatment may help prevent or delay some of this
damage. In general, treatment is recommended until it no longer provides a
clear benefit.

The National MS Society also says that treatment with medicine may be
considered after the first attack in some people who are at a high risk for MS
(before MS is definitely diagnosed).10

Your doctor may suggest that you take MS medicines because:

You have had symptoms that are most likely caused by multiple sclerosis, tests show you most likely have MS, and your doctor is confident that you have MS.

You have just been diagnosed with multiple
sclerosis, and early treatment may delay damage to your central nervous
system.

These medicines are the only ones proved to reduce the
frequency and severity of relapses and delay disability.

Compare your options

Compare

What is usually involved?

What are the benefits?

What are the risks and side effects?

Take MS medicines
Take MS medicines

You give yourself a shot
either daily, weekly, or several times a week (interferon beta or
glatiramer).

You take one or more pills every day (dimethyl fumarate, fingolimod, or teriflunomide).

You visit your doctor regularly for blood tests and to check your
progress.

These drugs can make relapses less severe and reduce how often
they occur.

Medicines can slow the spread of the disease by limiting new
areas of damage in the brain.

These drugs can reduce the chance of
disability.

These drugs
don't work for everyone. It is hard to predict who will
benefit.

These medicines are costly.

The
long-term risks of some of these drugs are not known.

Side effects of these medicines can include flu-like symptoms,
headaches, diarrhea, nausea, hair thinning, depression, chest pain, anxiety, flushing, and redness and swelling
at the injection site (for shots).

Don't take MS medicines
Don't take MS medicines

You visit your doctor
regularly to check your progress.

You try
steroid medicine to treat relapses.

You try
physical therapy,
occupational therapy, and other treatment at home to
adjust to living with MS.

You avoid the risks and
cost of medicines that you might not need or that may not work for you.

You avoid taking medicine for multiple sclerosis if you end up being diagnosed with a different condition.

You may
have a hard time dealing with relapses.

You may have a higher chance of becoming
disabled.

Long-term use of steroid medicine may lead to other
problems such as stomach ulcers, problems sleeping, and high blood pressure.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about treatment for multiple sclerosis

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

The MS
episodes I've had were fairly mild, but I'm worried that next time the symptoms
will be more severe. I don't think I'm being pessimistic by deciding to take
interferon. I think I'm giving myself the best chance to live a long and
healthy life.

Victor,
age 29

I have never been much of a risk-taker, and
my health is definitely not something I want to risk. My doctor recommends that
I take the medicine. Even if it turns out that I might not have needed
treatment for MS, I would rather err on the side of caution by starting therapy
now. I know I would really regret not doing the treatment if I had a relapse a
year from now or even a few years from now.

Carmen, age 37

I generally
try to avoid medicine when I can. My doctor really thinks it would be a good
idea for me to take the medicine, but I don't want to deal with the side
effects, and I'm not sure I like the idea of giving myself shots on a regular
basis. I don't want to take medicine "just in case" I have problems with MS
later. Besides, I can always reconsider if and when I have another episode.

Jamal, age
34

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to start taking medicine for MS

Reasons not to start taking medicine for MS

I want to try the medicine now, even though it might not work.

I don't want to take the medicine if it might not work.

More important

Equally important

More important

I worry that if I don't start treatment now, I may be sorry later.

I want to wait to see if my MS gets worse.

More important

Equally important

More important

I don't mind giving myself shots.

I don't want to give myself shots.

More important

Equally important

More important

I'm willing to live with the side effects of medicine.

I don't know if I can handle the side effects of medicine.

More important

Equally important

More important

I want to do whatever I can to make my attacks happen less often.

I want to try to handle my attacks without medicine.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking medicine

NOT taking medicine

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.

Do medicines work for everyone who has MS?

YesSorry, that's not right. Medicines can reduce the severity of attacks and may prevent or delay disability. But they don't work for everyone.

NoYou're right. Medicines can reduce the severity of attacks and may prevent or delay disability. But they don't work for everyone.

I'm not sureIt may help to go back and read "How well do medicines work for MS?" Medicines can reduce the severity of attacks and may prevent or delay disability. But they don't work for everyone.

2.

Can medicines help prevent some nervous system damage from MS?

YesYou're right. Early treatment may prevent or delay some nervous system damage.

NoSorry, that's not right. Early treatment may prevent or delay some nervous system damage.

I'm not sureIt may help to go back and read "What medicines are taken for MS?" Early treatment may prevent or delay some nervous system damage.

3.

If you decide not to start medicines now, are there other things you can try?

YesYou're right. Instead of medicines, you can try physical therapy, occupational therapy, and steroid shots to help manage your symptoms.

NoSorry, that's not right. Instead of medicines, you can try physical therapy, occupational therapy, and steroid shots to help manage your symptoms.

I'm not sureIt may help to go back and read "What if you don't take MS medicines?" Physical therapy and steroid shots are two things you can try.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Multiple Sclerosis: Should I Start Taking Medicines for MS?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

Take medicines after your first attack of multiple sclerosis or as soon as you are diagnosed.

Don't take medicines now. Wait to see how the disease
progresses.

Key points to remember

Your doctor may suggest medicines after your first attack or when
multiple sclerosis (MS) is first diagnosed. Lasting
damage to the
nervous system can occur in the early stages of MS.
Early treatment may prevent or delay some of this damage.

Some
people wait to see if their symptoms get worse before they make a decision to
start taking MS medicines. Instead of medicines, you can try physical therapy,
occupational therapy, and
steroid shots to help you manage your symptoms.

It's hard to know the course that your MS will take. Doctors
can't know for sure if your MS will get worse. A small number of people with MS
have only mild disease and do well without treatment. But many get worse over
time.

Medicines can reduce the severity of attacks of
relapsing-remitting MS and how often you have them.
They may also reduce or delay disability. But they don't work for everyone. And
there is no way to predict if they will work for you.

These medicines have side effects that can range from flu-like
symptoms to headaches, chest pain, flushing, infections, and allergic reactions to the injection. Some of these medicines can damage your liver or heart.

These medicines are costly.
Your cost will depend on your health plan coverage.

FAQs

What is multiple sclerosis?

Multiple sclerosis is a disease that affects the
central nervous system—the brain, spinal cord, and optic nerves. It is also called MS. It
can cause problems with muscle control and strength, vision, balance, feeling,
and thinking.

Your nerve fibers have a protective covering called
myelin . Without myelin, the brain and spinal cord
can't communicate with the nerves in the rest of the body. MS slowly destroys
myelin and nerve cells in the central nervous system. This causes muscle weakness and other
symptoms.

Most of the time, MS is not diagnosed unless a doctor
can be sure you have had at least two attacks affecting at least two different areas of your central nervous system . Your doctor will examine you,
ask you questions about your symptoms, and do some tests. An
MRI scan is often used to confirm the diagnosis. That's because
the patches of damage (lesions) caused by MS attacks can be seen with
MRI.

MS is different for each person. You may go through life with
only minor problems. Or you may become seriously disabled. Most people are
somewhere in between. In general, MS follows one of four courses:

Relapsing-remitting. This means symptoms fade and
then return off and on for many years.

Secondary progressive, which at first follows a
relapsing-remitting course and then becomes progressively worse. "Progressive" means it
gets worse over time.

Primary progressive. This means the disease is progressive from the
start.

Progressive relapsing. This means the
symptoms are progressive at first and are relapsing later.

What medicines are taken for MS?

Disease-modifying
therapy means treatment to delay, change, or interrupt the natural course of
the disease. For MS, this means taking medicine over a long period of time to
reduce not only the number of attacks but also how bad they are.

To slow down
the spread of MS, your doctor may suggest medicines after your first attack or when you are first
diagnosed with MS. People treated soon after being diagnosed with MS may have
better results than those who delay treatment. Lasting damage to the
nervous system can occur in the early stages of MS.
Early treatment may prevent or delay some of this damage.

Medicines for MS can be costly. They don't work for everyone. And it's hard to know who
will benefit.

The most commonly used medicines are:

Interferon beta (such as Betaseron).

Glatiramer (Copaxone).

Other disease-modifying medicines may also be used for relapsing-remitting MS. These medicines are available as pills that you take by mouth. They include:

Dimethyl fumarate (Tecfidera).

Fingolimod (Gilenya).

Teriflunomide (Aubagio).

Making a decision about starting disease-modifying therapy
can be hard, especially if your symptoms have been mild. Some people wait to
see if their symptoms get worse before they make a decision to start therapy. A
small number of people with MS may never have more than a few mild episodes and
never have any disability. But there is no way to know who will fall into this
group.

How well do medicines work for MS?

Medicines can't
cure MS. They don't stop disease activity or reverse nervous system damage that
has already happened. But drugs may reduce relapses and delay disability in
many people with relapsing forms of MS.

The medicines interferon beta and glatiramer have the most evidence to support how well they work. These medicines can reduce how often you have relapses and how bad the relapses are. They may also delay disability in some people and slow the number of new patches of damage (lesions).1, 2

The medicines dimethyl fumarate, fingolimod, and teriflunomide can also reduce the number of relapses in people who have relapsing-remitting MS.3, 4, 5 These medicines are newer and haven't been studied as long. So there isn't as much evidence yet for how well they work over time.

What if you don't take MS medicines?

If you decide not to try disease-modifying therapy at
this time, work with your doctor to monitor your health through regular
checkups and periodic MRI scans to evaluate whether the disease is progressing.
If new lesions are developing or existing lesions are growing, you may want to
reconsider your decision and begin treatment.

If you decide
not to take MS medicines, there are some other things you can do.

Take other medicine, such as
steroid medicine, to relieve symptoms during attacks
or relapses.

Try
physical therapy,
occupational therapy, and other treatment you can do
at home to help you manage your symptoms and adjust to living and working with
MS.

Do what you can to stay well. Eat a healthy
diet, get plenty of rest, and try to reduce
stress.

Some people try alternative therapy to reduce their symptoms. Before you try any type of alternative treatment for MS, talk with your doctor about your treatment options. You can also
get advice from an MS treatment center or the National Multiple
Sclerosis Society.

What do numbers tell us about benefits and risks of MS medicines?

This section focuses on glatiramer and interferon beta, the most commonly used MS medicines.

Risks

With interferon beta, 48 out of 100 may have flu-like symptoms. This means that 52 out of 100 may not. The quality of the evidence about this is moderate.

With glatiramer, 24 out of 100 may have symptoms such as flushing, chest tightness, sweating, heart palpitations, anxiety, and shortness of breath. This means that 76 out of 100 may not. The quality of the evidence about this is borderline.

Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.

Why might your doctor recommend these medicines?

The
National Multiple Sclerosis Society recommends that people with a definite
diagnosis of MS and active, relapsing disease start treatment with interferon
beta or glatiramer. Most
neurologists support this recommendation and now agree
that permanent damage to the
nervous system may occur early on, even while symptoms
are still quite mild. Early treatment may help prevent or delay some of this
damage. In general, treatment is recommended until it no longer provides a
clear benefit.

The National MS Society also says that treatment with medicine may be
considered after the first attack in some people who are at a high risk for MS
(before MS is definitely diagnosed).10

Your doctor may suggest that you take MS medicines because:

You have had symptoms that are most likely caused by multiple sclerosis, tests show you most likely have MS, and your doctor is confident that you have MS.

You have just been diagnosed with multiple
sclerosis, and early treatment may delay damage to your central nervous
system.

These medicines are the only ones proved to reduce the
frequency and severity of relapses and delay disability.

2. Compare your options

Take MS medicines

Don't take MS medicines

What is usually involved?

You give yourself a shot
either daily, weekly, or several times a week (interferon beta or
glatiramer).

You take one or more pills every day (dimethyl fumarate, fingolimod, or teriflunomide).

You visit your doctor regularly for blood tests and to check your
progress.

You visit your doctor
regularly to check your progress.

You try
steroid medicine to treat relapses.

You try
physical therapy,
occupational therapy, and other treatment at home to
adjust to living with MS.

These drugs can make relapses less severe and reduce how often
they occur.

Medicines can slow the spread of the disease by limiting new
areas of damage in the brain.

These drugs can reduce the chance of
disability.

You avoid the risks and
cost of medicines that you might not need or that may not work for you.

You avoid taking medicine for multiple sclerosis if you end up being diagnosed with a different condition.

What are the risks and side effects?

These drugs
don't work for everyone. It is hard to predict who will
benefit.

These medicines are costly.

The
long-term risks of some of these drugs are not known.

Side effects of these medicines can include flu-like symptoms,
headaches, diarrhea, nausea, hair thinning, depression, chest pain, anxiety, flushing, and redness and swelling
at the injection site (for shots).

You may
have a hard time dealing with relapses.

You may have a higher chance of becoming
disabled.

Long-term use of steroid medicine may lead to other
problems such as stomach ulcers, problems sleeping, and high blood pressure.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These
personal stories
may help you decide.

Personal stories about treatment for multiple sclerosis

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"The MS episodes I've had were fairly mild, but I'm worried that next time the symptoms will be more severe. I don't think I'm being pessimistic by deciding to take interferon. I think I'm giving myself the best chance to live a long and healthy life."

— Victor,
age 29

"I have never been much of a risk-taker, and my health is definitely not something I want to risk. My doctor recommends that I take the medicine. Even if it turns out that I might not have needed treatment for MS, I would rather err on the side of caution by starting therapy now. I know I would really regret not doing the treatment if I had a relapse a year from now or even a few years from now."

— Carmen, age 37

"I generally try to avoid medicine when I can. My doctor really thinks it would be a good idea for me to take the medicine, but I don't want to deal with the side effects, and I'm not sure I like the idea of giving myself shots on a regular basis. I don't want to take medicine "just in case" I have problems with MS later. Besides, I can always reconsider if and when I have another episode."

— Jamal, age
34

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to start taking medicine for MS

Reasons not to start taking medicine for MS

I want to try the medicine now, even though it might not work.

I don't want to take the medicine if it might not work.

More important

Equally important

More important

I worry that if I don't start treatment now, I may be sorry later.

I want to wait to see if my MS gets worse.

More important

Equally important

More important

I don't mind giving myself shots.

I don't want to give myself shots.

More important

Equally important

More important

I'm willing to live with the side effects of medicine.

I don't know if I can handle the side effects of medicine.

More important

Equally important

More important

I want to do whatever I can to make my attacks happen less often.

I want to try to handle my attacks without medicine.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking medicine

NOT taking medicine

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
Do medicines work for everyone who has MS?

Yes

No

I'm not sure

You're right. Medicines can reduce the severity of attacks and may prevent or delay disability. But they don't work for everyone.

2.
Can medicines help prevent some nervous system damage from MS?

Yes

No

I'm not sure

You're right. Early treatment may prevent or delay some nervous system damage.

3.
If you decide not to start medicines now, are there other things you can try?

Yes

No

I'm not sure

You're right. Instead of medicines, you can try physical therapy, occupational therapy, and steroid shots to help manage your symptoms.

Decide what's next

1.
Do you understand the options available to you?

Yes

No

2.
Are you clear about which benefits and side effects matter most to you?

Yes

No

3.
Do you have enough support and advice from others to make a choice?

Yes

No

Certainty

1.
How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2.
Check what you need to do before you make this decision.

I'm ready to take action.

I want to discuss the options with others.

I want to learn more about my options.

3.
Use the following space to list questions, concerns, and next steps.

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